Permit IN 0.''_Y ,� CITY OF TIGA ELECTRICAL PERMIT
1 2;� COMMUNITY DEVELOPMENT Permit #: ELC2009-00540
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/09/2009
TLG 9 Parcel: 2S103AC01504
• Jurisdiction: Tigard
Site address: 11175 SW FONNER ST
Subdivision: Lot: 0
Project: Erickson
Project Description: Rebond the water, gas, and add ground rods after plumbing took out metal water lines
Owner: FEES
ERICKSON LIVING TRUST Quantity Description Date Amount
BY GEORGE W /MARLENE I ERICKSON TRS,
11175 SW FONNER ST 1 ea Services or Feeders - 200 10/09/2009 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 10/09/2009 $12.08
Electrical
Contractor:
BEAR ELECTRIC
PO BOX 389
DONALD, OR 97020
PHONE: 503 - 678 -1355
FAX: 503 - 678 -1108
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and at other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 0 1 0 0 /. �J /
952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800..3322,2344.
Issued By: J4k W` _( `�—&T Permittee Signature: �0 J 1 1 e
111 OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
- .r
,0i3-08-2009( THU) 11 :20 Bear Electric (FRX)5036781108 P. 001 /002
oett
Electrical Permit Appllei tion 0 0 2 b, , > ' I (iii OFF►cc' usuciNtKi. , '` .rr° w"
x.1. City of Tigard OF'�1G IC. � galas r ` t - oO SLt 0
13125 SW N Plod, Tired. OR 9 GDV1. pl.R..i.w
. . • } "„ phone 303.639.4171 Fax: 503.5 1N v tkatOr �
. T i iu r, Inspection Line 503.639A1 75 'i Ore Reed,Oy: two ® Ste rage 2 ear
look aa+od Internee ww.tica dor.Rar NuditateMahod: _ Sappt.meotat (afarm ■tiao
7It7Z OF WORK PLAN =VIEW
O Newcoomuction ® Addision/altantion/replaeanalt tw:w ehx►asnot t"' b' d°x'^' otDtam.,ilaawaba1� btle.t:
OS mite or feats, 400 =poor wow ❑&Minnowaxedgaiet.
O Danolitim 0 Other: mum aw arsibedc bath rmrtaa O Marion Mai Unarm.
Gam' OP CONSTRUCTION mods 14000 amps at 150 wok; to ❑ Hawse buUdute.
leu 10 moot or names 14.000 O Commnculwwe ►pi[rlua1l
1. and 2•family dwelling 0 Commercialrindusuitd 0 Accessory building ears wr all oho in attniaa. t.,ildit0.
O Multi-family ❑ Master builder 0 Other: Cl Fire pulp. O amutanao of 75 KVA or
O-A ". -G".-t•
O
JOH RC & .INFORMATION AND LOCATION Downey ' s" 4teer Kpawl d
ta . deviled
guns.
t' twawl.aerws. croft. k.a .r r.-t -r.
Job n0.: I Job site address 1 ((l5 frvkir)Qr, S3r, 1:3 Sig a Mats t aadeatid oohs 0 Rn:taatioaal .chick pasta.
City/Stoic/ZIP: J ml � a - i27 i 17 iiube.otx Cocain a Q Supply R for mar, tins 1 l� ifawtuu 1001 WO. 600 wta nominal,
Suikibldglopt. sm.: Project name . O Swirl or Roder 610 amps err mow w
FEZ SCHFIDULB
Cross atrect/ditvetions to job sire pvnMwe 1 Wt.. t r.. 1 Tow i -.:-.,
New residential angle. or maid - (amity dwettiag loth.
Inch/dot attached enrage.
Subdivision: 1 Lot no.: 1.000 oq. iL or less 145.15 4
Ea. add9 500 R. a, or .. nion _ 33.40 I
Tax map/pored no.: .., United magi. residential ' t
75.00 7
.r DESCRIPTION••CF. WORK (web aho.e.q. e_)
Q t Umi cd enrol, tnuhl- f>nttily 75.00 2
(i RC� ? . l 1)Q -_� �s1., 0.r1()
i � otcl d residential (win/above o e e4, a) - --
.J S teat or feeders Instal atio- alters (o a d!o • don
Q 1 inZ11 cr l i Mh'1nc took C (
, :\ th( ,\ 200antpaortaaa MM 110.30 L ;(1 2
••O PRoPzzr1r- OIMIX 13 TENANT u K C" 201 antes to 400 amps 106.33 2
Name 1 Imes, 401 aorta to 600 amps I 160.60 2
601 snips 10 1000 amts 2 40.60 1 2
Address: _ Over 1.000 toms Orr yobs • 454.65 1
City/State/7 Temporary services or feeden laatatlallon. attrratioa. andfor
relocation
Phone ( ) Fnx: ( ) 200 amps or less 66.65 I
Owner Installation: This installation is bans made on property that 1 own which is not 201 amps to 400 amps 10030 2
intended for sole. lose, rent. or exchange. according to ORS 447, 449, 670, And 701. 401 amps to 399 aaatps 1 - 133.75 2
Owns tusnatutT~ Broach circuits- new�alteratton, or nreaslan, perpaael
A. Fee for branch circuits with
13 APPUCANr • ]. O CONTACT -PERSON abort service or fecde fee. 6.65
each branch circuit
Business name B. Foe for branch citeuits -
Canino name; without service or fecdcr !cc. 46,35 ,
tint branch circuit -
Address Each edd'1 haunch circwii 6.65 '-
tltlsedlanonns (ern4ee or feeder not included)
City/Sane/21 P: • Each manufactured or modular 90.90
• dwcninn, Dunk= mtVoe feeder
Phone ( ) Fax :: ( ) Reenonsl only 66.85 2
E•soail: Pump or lniRstioa cask 53.40 2
CONTRACTOR '''Sign cr outtina lighting ! 53.40 2
Business misseBearElectric. Inc. Signalrirt e ltlgatlmltai-
_ _ energy panel. aluratioal, or
Address PO Box 389 mansion. t)rs olsc Page 2
City/Stair/ZIP: Donald, OR 97020 Comb odallinnwa w.r..d... o..• .u..c.w. Its sow .f lb.. .Arm
Phony (503) 6734355 J Fax: (503) 6711.1108
Per inspection 62.50 1
' (nvadtipali per hour ti ht Mani 1 62.50 1
CCD Lic: 20919 / 1 E l e c t r i c a l Lie.: 24.107C ✓ I Suprv. Lie.: . 4 , A 9 ✓ t+ ' P 1� r I 73.75
r > 7t1CAL' PERMIT mars.
Staprv. FJmrician tusnatut� tsquirtxi: r.----. /4--- Subtotal: (Q ° •"7
U Plan ,whew 125% of permit fee):
P n ame d „ 1� S $ fii am" ��� ) Sla sutthirgc t t2%, of permit fcc): (2 . a
Authorizer) signature TOTAL PERMIT FEE: {
Fria! name
Date Tats prawn apparaaaa nom If a permit k not ;11 within 110 G,
days dor n as Mee h a*mined a, tompktt. ( l ?1(
• Meatier Oral w . ie,n /Mowed pet penat&
t. 613.( raaeaatoa.e 011106 44441lttl 1 01 COSI'w6:a
n:
CITY OF TIGAR® ELECTRICAL PERMIT
fM ~t
COMMUNITY DEVELOPMENT Permit ELC2009-00540
~
W:- Date Issued: 10/09/2009
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 103AC01504
Jurisdiction: Tigard
Site address: 11175 SW FONNER ST
Subdivision: Lot: 0
Project: Erickson
Project Description: Rebond the water, gas, and add ground rods after plumbing took out metal water lines
Owner: FEES
ERICKSON LIVING TRUST Quantity Description Date Amount
BY GEORGE W/MARLENE I ERICKSON TRS,
11175 SW FONNER ST 1 ea Services or Feeders - 200 10/09/2009 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 10/09/2009 $12.08
Electrical
Contractor:
BEAR ELECTRIC
PO BOX 389
DONALD, OR 97020
PHONE: 503-678-1355
FAX: 503-678-1108
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952J-0001--01100,. Y~oum~ayy obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800..~33Z2344.
Issued By: lk Permittee Signature: 1Tx- apJ
~U
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
OAT 08-2009(THU) 11;20 Bear Electric (FAX)5036781108 P.001/002
. ar
Electrical Permit ARDlientio 0
City of Tigard FT~G~R<<~ , SM d Patt■,r1~~~L' C) SSE U
13125 Sw "I III-d' Ttbi 4 OR 9 l O :ilv~
Pbo= 303.639.4171 fan: 503.5 NNcj t7ard0 .
Impa6 a UmC 503.639A I 75 `k7 P Oatr Iiaadsr0y » 0 Seo rap 2 for
(murk!: Wwwtigwor4ov MtldGtd~l4RboQ $aOPlfueelal lr!■rm.doo
*rm OF WORK PLAN RxvIKW
❑Neweoct=czion ®AdditinNalteration/taplaconent rA=Cbcdatltlmrawy("m4AwaordwW104MK maWb9wt:
~f ❑ ~ QSovim a ftadr 4OD aegs or moon 1:] Umlding war slum mobs,
u I~CrtiGlltinn wAtn m m a.sib0c 6tdr cnncw Matxw red horrid!,
G~'OR. X OP CONS IWCrION cxxWs 10,M paps as 150 wlu ar ❑ Fw*Wr bu4duML
leu w yeund ara amou IAJU 13 Coam miatwlr asti w wsl
St. and 2-kntily dwding j] CommtatWiindustrial D A=moty buildinr asks for au wler 6.Lm umw wiwi %
❑Multi•famil ❑Mm=builder ❑ON= 0 Firo1 ❑lmututiaeof73KVAor
rte~i.cd ty~rnn.
OCY pwat
JOB ZrIt VatOXMATION AM LDCJL7 ON 0A"ww - -A". -c,.
IODI
lob mo.: Job site addresx ~ or nr ntaa. «ermia
❑Sia ar awea►gasdrLlaaiu ❑ ltrcrotioapi•xpKkpxta
CitylState2lP ❑liabdumrMatim Qsuppb.dnarWrttwnrbHa
!.1IFuarduu loem6x boo wtu nominal,
5uita9bldg hart r><l: Pmjca namC ❑ Save& or faoder 6011 ompLs, or tvooL
FEE SCMULC
Crou slroWdi caions to job site r.. ,ow
Now re44milel a ftls. or molddamtly dwctlloa tudL
Iadudea otlachad Vera
Sub4lvis3ttn: lot no.: 1000 sq. IL or less 145.15 4
EL mWI Soo sq. (t. or portion 33.40 1
TA% toady na: Umitd e;rmV. nsldcnllsl
MESCMMON, OF WORK vkh 3h"c e. 7s on 7
umkad energy. mahl-f>,Wy 75.00 2
trxidcntial ■dmibere ,t6
yervteex ar feeders iaualtado a11MOa a a tto
~ 200 amps or los ttQ.3t1 ~
Q PROFMY OWNMt ❑ TERMr 201 arrasio400amid 1064$ 2
Name 1 \ rl 401 ergo to 600 atups 160.60 2
?40.60 ?
601 an" to I=
Athdrcds: Over 1.M amps or Vohs 454 65
City45tatemil Temporary servicm or herders Installation. alteralioa. andlor
raloeailon
200 ar 1css
phase ( ) Fnx: ( )
Owner iastaWoa: This irnWhoion is being made on property that I own wWoh Is not 201 eat to 400 snips !0030 2
intended foe stilt, lease, resit, or txdanM aeeotdittg to ORS 447, 449.670, and 7Q), Opt amps to S99 a 171.73 24
Owner silo oat= Date. Breach cfreau:- new snemmi or attaa►14 net
A. Fee for branch Cimulta W*
13 ApmjcANr ❑ CONTACT MUWS N; above 3mv ec or fe,cder fee. 6.65 '
n9Ch braaeh chcui►
Business namC B. Fa for bmmh Cie-uhs
Ctartwxttauc wldautscxviccorfcoderFM 46.83 ~
rim bm mb CI¢Uu
Addr= Each add-I brunch cirndt 6.65
Ntixewflanaoax tenlee or feeder aw Iteeiodad
Ciwstawmp: Fecu wuafacurrod or maduiar 90,90 2
d.vctlin ..cr.icc .,rtllor Cow"
Phones ( ) Fat::( ) Raman ct only 66.85
Equil: Pmu or iai ica t mc 53.40
C:OMMACWR Sip oraudinctighing 57.40 2
-
Business n=c bear h'slEWIC, Ina a elbcKt s)ot urnitiji
atergy patttcl, altaatioa. or
Address; PO got 389 east ttsioa IJescsibe Pare r
CityrStala MP: Dvaatd. OR 97020 s w stu...r rt.«....M.tt«.■t.t. t. ■n, ,rn».i.. w
per 1 tine b250
Phom(503)678-1355 Fax (30!)678.1IG8 fn bour(l btrain) 62-50
CC13 Lie: 2091:9 EJatriml lic_: :Z4.107C SUP". Lin.: IrAuWW teat prr 1■wr 7VIS
n =xm-RICAL Mawr YM
Suprv. @wrieimi signature. t>rgttircd: e, w Sulzreal; tQ 0 , -71'
Print name U s Clair. Plan trvicw f25x of hcrnit fad: :rz 0- 1 state surcha (12%orpamkfee): (2.
Authorize! sig mtuw- TOTAL PERMrr FEE:
ktc d ,ritbl■ 1w
Print n=w-- Dam Tbla pernlr dw ■a o h bteInp a ►aporno!!'rpW h A ca■mpJrtc
dll}a Ober It h hart
• Nwarbaroflmpatis■sdk~wcdtx*D~p„•
t, ttwWnrn~.rxK'.r..n~y.a.a o1 v a ..o.ru sri t t to cape vn:a